Clinical & Nursing
RN Care Advisor- Utilization Management
Louisville , KY, United States

It’s Time For A Change…Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

  • Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise.
  • Performs all work within specified timeliness requirements.
  • Review clinical information utilizing InterQual system for evidence based criteria for concurrent reviews, extending the length of stay for inpatients as appropriate. 
  • Documents clinical information in medical management system.
  • Performs Telephonic prospective, concurrent and retrospective utilization reviews.
  • Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
  • Promote improved quality of care and/or life
  • Promote cost effective medical outcomes
  • Prevent hospitalization when possible and appropriate
  • Promote decreased lengths of hospital stays when appropriate
  • Prevent complications in patients under our care when possible
  • Provide for continuity of care
  • Assure appropriate levels of care are received by patient
  • Provide appropriate consultation and referral to Care Management personnel.
  • Guides members into utilization of contracted physicians, facilities and healthcare service providers.
  • Assists in discharge planning working in partnership with hospitals and healthcare service providers.
  • Maintain accurate records of all interventions and provide timely verbal and written reports to clinical manager and associated clients as directed by policy
  • Assist with data collection as requested to support UM Manager/Director’s reporting requirements

The Experience You’ll Need (Required):

  • A current, valid, unrestricted Kentucky RN License
  • Associates Degree in Nursing.

Finishing Touches (Preferred):

  • Previous training and demonstrated competence in keyboarding/computer use as well as proficient end-user capabilities in Microsoft Word and Outlook.
  • Exceptional communication skills, both written and oral, ability to positively influence others with respect and compassion.
  • Ability to navigate ambiguity with the aid of structured problem solving techniques.
  • Prior experience with Utilization Management in a managed care organization is a plus.

Evolent Health is an Equal Opportunity/Affirmative Action Employer

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